Updated HIV guidelines issued
The U.S. Department of Health and Human Services issued updated guidelines April 8 on use of antiretroviral treatment in HIV-infected adults and adolescents.
The U.S. Department of Health and Human Services issued updated guidelines April 8 on use of antiretroviral treatment in HIV-infected adults and adolescents.
The updated guidelines, which are a revision of previous guidelines from May 2014, include significant changes to regimens for treatment-naïve patients. Five regimens, 4 involving integrase strand transfer inhibitors (INSTIs) and 1 involving ritonavir-boosted protease inhibitor (PI/r), are now recommended in this group.
The INSTI-based regimens are as follows:
- dolutegravir/abacavir/lamivudine (DTG/ABC/3TC), only for patients who are HLA-B*5701 negative;
- DTG plus tenofovir disoproxil fumarate/emtricitabine (TDF/FTC);
- elvitegravir/cobicistat/TDF/FTC (EVG/c/TDF/FTC), only for patients with a creatinine clearance above 70 mL/min before antiretroviral therapy; and
- raltegravir (RAL) plus TDF/FTC.
The PI/r-based regimen is darunavir/ritonavir (DRV/r) plus TDF/FTC.
Atazanavir/ritonavir (ATV/r) plus TDF/FTC and efavirenz (EFV)/TDF/FTC were previously classified as recommended regimens but have been moved to the alternative regimens category in this update based on recent research, the update said.
In addition, 3 regimens (ATV/r plus ABC/3TC, EFV plus ABC/3TC, and rilpivirine/TDF/FTC) previously listed as recommended regimens for patients with a baseline HIV RNA level below 100,000 copies/mL or a CD4 count above 200 cells/mm3 are now listed in the alternative or other category. Two regimens using fewer than 2 nucleoside reverse transcriptase inhibitors (DRV/r plus RAL and lopinavir/ritonavir plus 3TC) are now listed as other regimens; their use should be limited to patients who cannot take TDF or ABC. Finally, coformulations of ATV and DRV with the pharmacokinetic enhancer cobicistat have been added to the options for alternative regimens.
Other sections of the guidelines with significant updates include virologic failure, poor CD4 cell recovery and persistent inflammation despite viral suppression, acute/early HIV infection, HIV-2 infection, HIV/hepatitis C co-infection, and drug interaction. Minor changes have also been made to some additional sections.
A summary of the changes and the complete guidelines are available online.